IRS Form 1095-A – Fill, Sign and Download | Marketplace Statement
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Form 1095-A is the Health Insurance Marketplace Statement issued by HealthCare.gov or a state-based Marketplace to individuals and families who enrolled in a qualified health plan during the tax year. It reports each month of coverage, the monthly premium paid, the cost of the second-lowest-cost Silver plan (SLCSP) used to calculate the premium tax credit, and any advance premium tax credit applied to lower the premium during the year.
You receive Form 1095-A if you, your spouse, or anyone you claim as a dependent was enrolled in a Marketplace health plan for one or more months of the tax year. The Marketplace sends the form by mail and posts it to your HealthCare.gov account by January 31 of the following year.
Form 1095-A is the source document for IRS Form 8962, Premium Tax Credit. You use the monthly figures from 1095-A to reconcile any advance premium tax credit you received against the credit you're actually entitled to based on your final household income and family size. The reconciliation either increases your refund or your balance due.
If any month's coverage, premium, or SLCSP figure is incorrect, contact the Marketplace as soon as you can to request a corrected Form 1095-A. Don't file your return based on the wrong form — wait for the corrected version, then complete Form 8962 from the corrected numbers.
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